Provider Demographics
NPI:1255463964
Name:CHILD HEALTH CARE ASSOCIATES PRACTICE OF PEDIATRICS
Entity Type:Organization
Organization Name:CHILD HEALTH CARE ASSOCIATES PRACTICE OF PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-463-2013
Mailing Address - Street 1:6700 KIRKVILLE RD.
Mailing Address - Street 2:SUITE A.
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9305
Mailing Address - Country:US
Mailing Address - Phone:315-463-2013
Mailing Address - Fax:315-463-2019
Practice Address - Street 1:6700 KIRKVILLE RD.
Practice Address - Street 2:SUITE A.
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9305
Practice Address - Country:US
Practice Address - Phone:315-463-2013
Practice Address - Fax:315-463-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02053941Medicaid